Deafness is present in a large proportion of the elderly and has been hypothesized as a risk factor for dementia. Previous studies which explored this hypothesis contain serious methodologic flaws and produced conflicting results. Case-control and cross-sectional studies of deafness as a risk factor for cognitive dysfunction in Senile Dementia of the Alzheimer's Type (SDAT) will be performed. Cases are 50 SDAT patients and controls are 50 patients without dementia at Univ. of Washington clinics. Subjects will be interviewed to obtain historical data. They will also undergo a standardized mental status evaluation and extensive audiologic, and otologic evaluations. Data will be analyzed to determine if an increased prevalence of deafness exists in cases vs. controls as well as to determine the relationship of severity of hearing loss and dementia among SDAT patients. Significant independent associations may have important implications for the prevention and management of dementia. Quality of life factors are frequently considered in geriatric medicine decisions. This study will compare physician, geriatric patient, and spouse (who is often surrogate decision maker for incompetent patient) attitudes about quality of life in a geriatric medicine context. Questionnaires will be administered to approximately 90 academic, community, and nursing home physicians of outpatient geriatric care, 350 geriatric patients and 130 of their spouses. For each patient, respondents will describe medical events in the preceding year which affected the patient's quality of life, assess the overall quality of the patient's life and selected components of it, and complete simulated case management problems concerning values and actions attributable to quality of life assessments. This study will provide basic knowledge with clinical and policy implications about quality of life in elderly patients. In addition to research responsibilities, the principal investigator will direct the Harborview Medical Center inpatient SeniorCare program and have teaching responsibilities for medical students, house officers and fellows.